2014-08-15T12:09:58-05:00 2013-09-30 550486667 Arnett Foster Toothman PLLC P O Box 2629 Charleston WV 25329 990 2012-10-01 550357050 St Mary's Medical Center STMA 3045268931 2900 First Avenue Huntington WV 257021271 Michael Sellards 3045268931 2014-08-14 1 Harry C Harless P01042847 3043460441 2012 2015-11-30 17:44:51Z Michael Sellards 2900 First Avenue Huntington WV 257021271 435762493 0 X www.st-marys.org X 1924 WV Hospital with open emergency room. 12 11 2972 355 0 0 819525 1283058 387668763 394093113 3048203 3937119 -1711710 165583 389824781 399478873 570850 339518 0 0 164415846 168328228 0 0 0 209898182 213329894 374884878 381997640 14939903 17481233 326242340 348476161 239555098 230958699 86687242 117517462 X We are inspired by the love of Christ to provide quality health care in ways which respect the God-given dignity of each person and the sacredness of human life. 0 0 329121489 339518 389993844 St. Mary's Medical Center was established in 1924 and, based on thecore values of compassion, hospitality, reverence, trust, interdependency, and stewardship, continues to provide high quality healthcare services to residents of Huntington, West Virginia and the surrounding area. Services are provided without regard to the patient's race, creed, sex, national origin, age, or handicap. Furthermore, while reimbursement for care provided is crucial to the continued operation of St. Mary's Medical Center, it is recognized that circumstances existwhich render certain parties unable to pay for needed services, and no patient is denied services due to the lack of ability to pay. During the fiscal year which ended September 30, 2013, St. Mary's Medical Center provided 99,497 days of inpatient days of care and treated an additional 264,838 patients in the emergency and outpatient settings.Approximately 73.6 percent of the inpatients served were covered by governmental programs, such as Medicare and Medicaid. A similar percentage is applicable to outpatient services. Since care provided to Medicare and Medicaid beneficiaries is subject to contractual reimbursement restrictions, payment received for services provided is often significantly below the actual cost of the services. St. Mary's Medical Center has established charity care policies and guidelines, used to help identify those patients who genuinely do not have the resources to pay for services received. During fiscal 2013, the hospital provided approximately $14.5 million dollars in charity care services, representing care provided at reduced prices or completely free of charge. These services include inpatient services, an adult outpatient clinic,a handicapped children's clinic, and a specialty pregnancy clinic. Also, St. Mary's Medical Center exceeds the guidelines established for the West Virginia ad valorem statute. 1116128 384053 370000 In addition to those patients without the wherewithal to pay for services rendered, we assist in the relief of burden of government for several programs. A strong auxiliary (operated as a department of the hospital) exists, which contributes heavily to the activities of SMMC. During fiscal 2013, the auxiliary made cash donations of approximately $370,000. In addition, volunteers provided over 39,053 hours of service valuable to promoting the mission and activities of the hospital. 9290436 4866524 St. Mary's Medical Center also recognizes that carrying out its mission of community service is not confined to the walls of the hospital's buildings and that there are residents in need of services who may never be a registered patient of the hospital. In meeting the needs of these individuals and groups, St. Mary's Medical Center provides or participates in numerous educational activities, support groups and health screenings and provides human resources, as appropriate, to support other charitable organizations. A summary of these community services as prepared by the hospital's mission integration department for the Catholic Health Association is listed below.Kids In Motion - Kids In Motion is a fun and innovative exercise and nutrition program designed to improve the health of Tri-State area children. It began as a new program in early 2013 as a joint initiative with the Huntington YMCA and other community health partners and even includes a competing hospital, with everyone working together to fight childhood obesity. It is the only program of its kind in West Virginia. At the heart of the program is Kid Fit, a 10-week program to get kids ages 5-14 moving and having fun, while also learning about fitness and nutrition. Weight, body mass index, body fat percentage and blood pressure are tracked throughout the program to measure progress and to customize the program to fit each child. During Kid Fit, children utilize exergaming equipment, which combines video games and exercise. Parents are also encouraged to participate and entire families are losing weight and getting healthier because of the program.St. Mary's has committed tremendous financial resources to providing equipment and staff and St. Mary's provided the key leadership role in planning and development of the program. Several local families are already providing testimony about how Kids in Motion has helped them.Events - The Annual St. Marys Tri-State Triathlon was held in August and includes three separate races - a triathlon, triathlon relay and duathlon. The triathlon consists of a half-mile swim, 15-mile bike ride and 2.9-mile loop run. In the duathlon, the swim course is replaced by a 2.9-mile loop run in the opposite direction of the previous loop. Races use computer-chip timing. The event averages 200+ participants each year but it has a wider reaching impact of promoting fitness in the community with news coverage of stories about first time participants and their ability to complete a triathlon. Many family and friends also gather at the event as spectators and some are inspired to compete in the next year's event. www.healthtristate.orgThe St. Mary's Kids Try-A-Triathlon for ages 6-14 was also held in August. Races consist of either a 50- or 100-yard swim, a two- or four-mile bike course, and a one- or two-mile run, depending on the age group. There is a kids camp leading up to this event that helps train young people to participate in the triathlon. Race day participation 100+.PATH Project St. Mary's is a sponsor of the Paul Ambrose Trail for Health (PATH) project which is designed to develop a 26-mile bicycle and pedestrian path system that will link the various Huntington parks. This project will promote wellness by offering family-healthy area throughout Huntington for the public. FitFest is held annually each year on 9-11 to focus the entire community on fitness and St. Mary's is a major sponsor. 500+ participants at FitFest. Web site: www.paulambrosetrailforhealth.orgAHA Heart Walk and Go Red Luncheon St. Mary's has been the main sponsor for the Heart Walk each year in April. As one of St. Mary's major service lines, the Regional Heart Institute promotes healthy heart activities for the public throughout the year, but the Heart Walk and the Go Red Luncheon for Women are two of our main events. The Heart Walk generates team building by raising funds for the American Heart Association, ending with the actual walk at Ritter Park. St. Mary's employee teams are joined by teams all across Cabell and Wayne Counties both raising funds for heart research and supporting walking as a family heart-healthy activity. 800+ people participant each year for the walk. The cause receives wider exposure through advertising heart healthy education tips and information. www.heart.orgPATH to the Cure - St. Mary's is the major sponsor for this 5/K run/walk in September that raises close to $100,000 per year. A majority of the proceeds pay for mammograms for uninsured and underinsured women in the Tri-State. The rest of the money goes to the PATH project mentioned previously. www.pathtothecure.orgHealth Screenings - Additionally St. Mary's participates in numerous health fairs throughout the year. They provide screenings for health issues such as cholesterol, blood sugar, HDL, osteoporosis, etc. at no charge. Also, education about various health issues such as stroke risk, joint replacement surgery, and other health risk factors are provided. There are 1000+ people screened each year through free screenings. www.st-marys.orgOther Fitness Events - St. Mary's also sponsored many other races and walks that promoted wellness and fitness and those include the Ridge to River 10 mile trail run in June, the St. Mary's Veteran's Memorial Day 5K run in May in Ironton, Ohio, the Herald Dispatch West Virginia 5K in June, the Marshall/St. Mary's Marathon in November, and the St. Mary's/Lion's Club 5K in March. 339528053 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 125 0 1 2972 1 0 0 0 0 0 0 0 0 0 0 X 12 11 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Angela Swearingen 3045268931 2900 First Avenue Huntington WV 25702 X Sister Gail Borgmeyer 1.00 39.00 X 0 0 0 Michael G Sellards 34.00 6.00 X X 0 843106 32712 Sister Marian Ruth Creamer 2.00 38.00 X 0 0 0 Sister Joanne Obrochta 1.00 X 0 0 0 Tom Houvouras 2.00 X 0 0 0 Julia Hutchison 1.00 X 0 0 0 Jeff Leaberry MD 1.00 X 0 0 0 Tim Daly MD 1.00 X 0 0 0 Richard Muth 1.00 X 0 0 0 Sister Diane Bushee 34.00 6.00 X 0 0 0 Sister Elisabeth Heptner 1.00 X 0 0 0 Matt Miller 1.00 X 0 0 0 Todd Campbell 34.00 6.00 X 0 409558 32305 Angela D Swearingen 34.00 6.00 X 0 288916 29970 Vera Rose MD 40.00 X 264573 0 30323 Susan Beth Robinson 40.00 X 224696 0 29714 Timothy Parnell 40.00 X 211554 0 29320 Elizabeth Bosley 40.00 X 190520 0 28689 Ernest Taylor 40.00 X 315095 0 23938 Sonya Arthur 40.00 X 151402 0 27515 Rita Barker 40.00 X 158067 0 21330 Jeffrey Hamrick 40.00 X 145705 0 27344 David Delimpo 40.00 X 144038 0 20909 David Sheils 1.00 39.00 X 148103 0 27416 1953753 1541580 361485 69 0 1 0 University Physicians & Surgeons 1600 Medical Center Drive Ste B501 Huntington WV 25701 Medical 3895358 American Red Cross 4 Chase Metrotech Center 7th Floor Brooklyn NY 11245 Medical 2379208 Ultimate Health Services 1115 20th St Huntington WV 25703 Medical 1698538 Alliance Heathcare Services PO box 96485 Chicago IL 60693 Medical 1587407 Aramark Corporation 12483 Collections Center Drive Chicago IL 60693 Biomedical Services 1578116 57 100100 1182958 1283058 Patient Service Revenue 621400 388895870 388895870 Purchase Rebates 900099 2440610 2440610 School of Nursing 611600 1141454 1141454 School Radiology 611600 453309 453309 1161870 1161870 394093113 2024773 2024773 1137255 0 1137255 1137255 1137255 37057791 56879 35202324 0 1855467 56879 1912346 1912346 451801 1081296 -629495 -629495 Cafeteria Sales 722100 2941665 2941665 Maintenance of Sisters 811000 54000 54000 Other Investment Income 900099 -6821230 -6821230 3483388 3483388 -342177 399478873 395230368 0 2965447 339518 339518 1403086 1193184 209902 116137812 98763595 17374217 6481781 5512107 969674 34082895 28984094 5098801 10222654 8693345 1529309 1276552 1276552 252000 252000 37744096 32097579 5646517 2558926 2176111 382815 23872785 20301416 3571369 3892067 3309814 582253 4845470 4120588 724882 156849 133384 23465 392 333 59 3452412 2935931 516481 15318691 13027015 2291676 1671410 1421367 250043 Medical supplies 61800132 61800132 Bad debts 34414458 34414458 Provider tax 10228778 10228778 Repairs & Maintenance 10104899 8593206 1511693 1739977 1482098 257879 381997640 339528053 42469587 0 5027 5027 13319721 24701608 79289937 86769382 10314370 9676692 6951651 2780813 395911539 255726362 134754396 140185177 71322242 73828282 6046973 7398405 4238023 3130775 326242340 348476161 31883988 37426328 7213 13079 95010276 88875645 1813073 1084871 110840548 103558776 239555098 230958699 X 84902717 115428707 1784525 2088755 86687242 117517462 326242340 348476161 X 17481233 4523622 8825365 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 7014431 7014431 169640383 107760338 61880045 207065434 145879133 61186301 12191291 2086891 10104400 140185177 Deferred salaries & wages 1709926 General reserves 5463646 Accrued pension costs 94698687 St Mary's Medical Management LLC 1686517 103558776 1 1 1 X 1 X 1 1 1 0 1 1 11581 5134412 0 5134412 0.01340 40075 52358592 43792201 8566391 0.02240 51656 57493004 43792201 13700803 0.03580 3119 1526 0 1526 0.00000 454 8982926 4866524 4116402 0.01080 7152 242194 0 242194 0.00060 10725 9226646 4866524 4360122 0.01140 62381 66719650 48658725 18060925 0.04720 1 278 28237 28237 0.00010 1 4222 35553 35553 0.00010 2 4500 63790 63790 0.00020 1 12162069 2432414 110539608 110448359 91249 X 1 1 1 Huntington Area MRI Provide MRI scans. 0.49000 0.51000 2 St Mary's Occupational Health Occupational therapy. 0.51000 0.49000 1 1 St Mary's Medical Center

2900 First Avenue Huntington WV 25702

X X X X St Mary's Medical Center 1 1 X X X X X X X X X 12 1 1 1 X X X X X X X X X 0 0 1 1 100.000000000000 1 200.000000000000 1 X X X X X X 1 1 X X X X 1 0 X X X 1 X 0 0 Part I, Line 3c: Eligibility is determined by comparing household family income against the income poverty guidelines for financial indigence; a ratio of total medical expenses to annual disposable income for medical indigence. Income is defined as the total annual cash receipts before taxes from all sources.Financially indigent. Uncompensated care shall include unreimbursed services to the financially indigent. Financially indigent shall mean uninsured or underinsured patients accepted for care with no obligation or a discounted obligation to pay for services rendered based on the medical center's eligibility system which may include:(a) income levels and means testing or other criteria for determining a patient's inability to pay; or (b) other criteria for determining a patient's inability to pay that are consistent with the medical center's mission and established policy. The federal poverty level shall serve as an index for the threshold below which patients receiving care at St. Mary's Medical Center are deemed financially indigent. Financially indigent services include noncovered services for patients eligible for the Medicaid program, services providedunder county indigent care contracts, and other state or federal assistance programs for low income groups.Medically indigent. Uncompensated care shall include unreimbursed services to the medically indigent. Medically indigent shall mean patients who are responsible for their living expenses, but whose medical and hospital bills, after payment by third party payers, where applicable, exceed: (a) a specified percentage of the patient's annual gross income (i.e., catastrophic medical expenses) in accordance with the Medical Center's formal eligibility system in such instances where payment would require liquidation of assets critical to living or earning a living; or (b) the criteria for determining a patient's inability to pay.While financial indigence is based strictly on an income level, medical indigence considers both income and the financial obligation for healthcare services to calculate the patient's ability to pay without liquidating assets critical to living or earning a living, such as a home, car, personal belongings, etc. Therefore, patients are considered for medically indigent status on a case by case basis. The patient would be required to provide documentation of income to determine if he/she is to be considered medically indigent. All patients are eligible to be considered for medically indigent status with the exception of patients with income below 200% of the federal poverty level as these patients are considered for some level of uncompensated care under the financially indigent category. Part I, Line 6a: SMMC prepares an annual written report that describes programs and services that promote the health of our community. The Community Benefit Report provides valuable information on programs and services provided by the Medical Center. The report is distributed to Hospital board members but it has not been distributed to the general public. The report is compiled using the program "A Guide for Planning and Reporting Community Benefit." Part I, Line 7: The cost to charge ratio as calculated from worksheet 2 was used to determine community benefit expenses for all subsidized health services. Part II: St. Mary's has sponsored a number of community building activities during the past year that promote wellness and help enrich the lives of people in the Tri-State. Some of these are as follows:Kids In Motion - Kids In Motion is a fun and innovative exercise and nutrition program designed to improve the health of Tri-State area children. It began as a new program in early 2013 as a joint initiative with the Huntington YMCA and other community health partners and even includes a competing hospital, with everyone working together to fight childhood obesity. It is the only program of its kind in West Virginia. At the heart of the program is Kid Fit, a 10-week program to get kids ages 5-14 moving and having fun, while also learning about fitness and nutrition. Weight, body mass index, body fat percentage and blood pressure are tracked throughout the program to measure progress and to customize the program to fit each child. During Kid Fit, children utilize exergaming equipment, which combines video games and exercise. Parents are also encouraged to participate and entire families are losing weight and getting healthier because of the program.St. Mary's has committed tremendous financial resources to providing equipment and staff and St. Mary's provided the key leadership role in planning and development of the program. Several local families are already providing testimony about how Kids in Motion has helped them.Events - The Annual St. Marys Tri-State Triathlon was held in August and includes three separate races - a triathlon, triathlon relay and duathlon. The triathlon consists of a half-mile swim, 15-mile bike ride and 2.9-mile loop run. In the duathlon, the swim course is replaced by a 2.9-mile loop run in the opposite direction of the previous loop. Races use computer-chip timing. The event averages 200+ participants each year but it has a wider reaching impact of promoting fitness in the community with news coverage of stories about first time participants and their ability to complete a triathlon. Many family and friends also gather at the event as spectators and some are inspired to compete in the next year's event. www.healthtristate.orgThe St. Mary's Kids Try-A-Triathlon for ages 6-14 was also held in August. Races consist of either a 50- or 100-yard swim, a two- or four-mile bike course, and a one- or two-mile run, depending on the age group. There is a kids camp leading up to this event that helps train young people to participate in the triathlon. Race day participation 100+.PATH Project St. Mary's is a sponsor of the Paul Ambrose Trail for Health (PATH) project which is designed to develop a 26-mile bicycle and pedestrian path system that will link the various Huntington parks. This project will promote wellness by offering family-healthy area throughout Huntington for the public. FitFest is held annually each year on 9-11 to focus the entire community on fitness and St. Mary's is a major sponsor. 500+ participants at FitFest. Web site: www.paulambrosetrailforhealth.orgAHA Heart Walk and Go Red Luncheon St. Mary's has been the main sponsor for the Heart Walk each year in April. As one of St. Mary's major service lines, the Regional Heart Institute promotes healthy heart activities for the public throughout the year, but the Heart Walk and the Go Red Luncheon for Women are two of our main events. The Heart Walk generates team building by raising funds for the American Heart Association, ending with the actual walk at Ritter Park. St. Mary's employee teams are joined by teams all across Cabell and Wayne Counties both raising funds for heart research and supporting walking as a family heart-healthy activity. 800+ people participant each year for the walk. The cause receives wider exposure through advertising heart healthy education tips and information. www.heart.orgPATH to the Cure - St. Mary's is the major sponsor for this 5/K run/walk in September that raises close to $100,000 per year. A majority of the proceeds pay for mammograms for uninsured and underinsured women in the Tri-State. The rest of the money goes to the PATH project mentioned previously. www.pathtothecure.orgHealth Screenings - Additionally St. Mary's participates in numerous health fairs throughout the year. They provide screenings for health issues such as cholesterol, blood sugar, HDL, osteoporosis, etc. at no charge. Also, education about various health issues such as stroke risk, joint replacement surgery, and other health risk factors are provided. There are 1000+ people screened each year through free screenings. www.st-marys.orgOther Fitness Events - St. Mary's also sponsored many other races and walks that promoted wellness and fitness and those include the Ridge to River 10 mile trail run in June, the St. Mary's Veteran's Memorial Day 5K run in May in Ironton, Ohio, the Herald Dispatch West Virginia 5K in June, the Marshall/St. Mary's Marathon in November, and the St. Mary's/Lion's Club 5K in March. Part III, Line 4: The text of the footnote reads as follows: "the Hospitals provide care to patients who meet specific criteria, defined by their charity care policies, without charge or at amounts less than their established rates, as approved by the West Virginia Health Care Authority (HCA). Because the Hospitals do not pursue collection of amounts determined to qualify as charity care, such amounts are not reported as revenue."The hospital's cost-to-charge ratio was used to compute bad debt expense at cost. Part III, Line 8: Patient level detail data is used to calculate the uncompensated cost of bad debt and charity. Once an account is written off to bad debt and/or charity, the entire cost of the account is classified as bad debt and/or charity and any payments received are netted against the cost of the account to determine the uncompensated costs.The cost-to-charge ratio as reported on the facility's Medicare Cost Report was used to compute the Medicare allowable costs. Part III, Line 9b: The hospital provides care to patients who meet specific criteria, defined by its charity care policy, without charge or at amounts less than the rates approved by the West Virginia Health Care Authority. Because the hospital does not pursue collection of amounts determined to qualify as charity care, such amounts are not reported as revenue. Part V, Section A: This facility includes a school of nursing, school of respiratory therapy, a school of medical imaging and a clinical pastoral education program. Interns and residents from Marshall University School of Medicine are also assigned at the hospital for their clinical rotations as are students in community based Practical nursing programs. St. Mary's Medical Center Part V, Section B, Line 3: In conducting the Community Health Needs Assessment for St. Mary's Medical Ctr., the medical center took into account input from representatives of the community served by the medical center, including those with special knowledge of or expertise in public health. The CHNA was done in collaboration with Cabell Huntington Hospital and the local health department of the service areas identified. A third party specialist, the Center for Entrepreneurial Studies and Development, Inc. located in Morgantown, WV was engaged to assist in the planning and development process. SMMC established a core planning team consisting of representative members of the medical center management: Director of Provider Relations, VP of Mission Integration, Sr. VP & COO, VP of Support Services, Planning & Development and the VP of Finance & CFO. St. Mary's Medical Center Part V, Section B, Line 4: Cabell-Huntington Health DepartmentWayne County Health DepartmentLincoln County Health DepartmentCabell Huntington Hospital St. Mary's Medical Center Part V, Section B, Line 7: The SMMC action plan focused upon three overarching goals: building a network of collaboration, enhancing education and awareness activities, and tailoring interventions for specific demographic groups with an emphasis on senior awareness. Each priority was evaluated to determine if SMMC currently was addressing that need, able to adapt current programs or develop new programs to meet the need, provide an agency that is currently addressing the needed financial support, or if there were insufficient resources (financial or personal) to address the need without collaboration with other agencies. Priorities that were deemed to be outside the scope of SMMC and addressed by other resources in the community were not included in the action plan. St. Mary's Medical Center Part V, Section B, Line 20d: The maximum amount that a FAP entitled and eligible guarantor would be billed is 64% of gross charges; calculated as a 20% discount applied to every uninsured account (regardless of FAP eligibility) and a minimum of an additional 20% discount of the remaining balance based on family income at 180% - 200% of the FPG. Part VI, Line 2: SMMC takes steps to determine what the most pressing needs are in order provide services to address them. The hospital regularly assesses the needs of the community. Periodic needs assessments are conducted in partnership with our local health department. Additionally, we monitor county, state, and national health indicators and work in partnership with service agencies in the communities we serve to meet identified needs. Part VI, Line 3: SMMC employs a variety of methods to reach patients with information about financial assistance, including:* Financial assistance posters are displayed in all emergency,admitting, outpatient, and clinic areas that include a phone numberto call for financial assistance counseling.* Hospital departments that have initial contact with incominginpatients and outpatients are supplied with brochures aboutfinancial assistance for distribution to patients and family members.* The hospital employs trained financial assistance counselors whowork individually with patients to assess financial need andrecommend appropriate assistance such as application for federaland/or state programs; qualification for charity care; determinationof automatic discounts and/or further reductions in charges; andsetting up long-term financial arrangements. Part VI, Line 4: St. Mary's Medical Center serves the greater Huntington, West Virginia community with a primary service area that includes Cabell, Wayne, Mason, Putnam and Lincoln counties in West Virginia and Lawrence County in Ohio. St. Mary's also serves a much wider service area because of specialty medical services including advanced emergency trauma care, advanced stroke care, advanced spine care, advanced heart care, advanced cancer care, and advanced orthopedic care. That secondary service area includes Logan and Mingo counties in West Virginia, as well as Boyd, Greenup, Carter, Lawrence, Johnson, Floyd and Pike Counties in Kentucky and Scioto and Gallia Counties in Ohio. Competitors within our primary service area are Cabell Huntington Hospital (Cabell County) and CAMC Teays Valley (Putnam County).The most recent statistics from the U.S. Census Bureau show that the high school graduation rate (age 25+) for Huntington is 86.0%. The percentage of Huntington residents living below that Federal poverty level is 30.2%. Cabell County birth rates for 15 to 19 year-olds is 42.3 per 1000 females. Part VI, Line 5: St. Mary's operates an emergency room that is open to all persons regardless of ability to pay and has an open medical staff with privileges available to all qualified physicians in the area. The board of directors represents medical and business professionals, as well sisters from the Pallottine Missionary Sisters. All provide hours of service in support of our hospital. They are deeply involved in our needs assessment process, building programs and services, and community outreach to ensure that people know about services available to them through our hospital.St. Mary's engages in medical and scientific research programs; engages in the training and education of health care professionals: physicians, nurses, medical imaging techs, respiratory techs, and chaplains; and participates in Medicare, Medicaid, and other government-sponsored health care programs.St. Mary's adheres to community benefit guidelines outlined in the Catholic Health Association's publication, "A Guide for Planning and Reporting Community Benefit."Community benefit work is driven by community health needs and directed in collaboration with other health care organizations and the broader community. Community benefit strategies are integrated in the organizational strategic plan. Programs are located throughout the organization, and staff and board education is conducted. Dedicated staff is committed to community benefit efforts.The St. Mary's Foundation is a non-profit organization that provides grant writing and fundraising for both medical center programs and for community benefit programs that reach both the poor and the broader community. Operations of the Foundation are governed by a separate Foundation board with voluntary memberships from the local community.When St. Mary's has excess revenue over operating expenses, we use those funds to obtain current health care technologies and equipment, improve patient care, provide medical training education and research, and to expand access to points of care. These investments ensure that we will be here to care for future generations. Part VI, Line 6: St. Mary's Medical Center is a not-for-profit health care facility wholly sponsored by Pallottine Health Services, Inc. (PHS). Pallottine Health Services is a ministry of the Pallottine Missionary Sisters and includes both St. Joseph Hospital of Buckhannon, West Virginia and St. Mary's Medical Center of Huntington, West Virginia. Both of these hospitals are committed to the core values of compassion, hospitality, reverence, interdependence, stewardship, and trust. Reports Filed With States Part VI, Line 7 WV 1 American Heart Association 162 Court St Charleston WV 25301 135613797 501(c)(3) 20000 For general operations of the Association in furtherence of their mission to reduce heart disease. Huntington Museum of Art 2033 McCoy Road Huntington WV 25701 530372921 501(c)(3) 10000 For general operations of the Museum. Rahall Transportation Institute Foundation PO Box 5425 Huntington WV 25703 550683361 501(c)(3) 10000 To help promote transportation safety. Huntington Area Development Council 916 Fifth Ave Huntington WV 25701 550714570 501(c)(3) 25000 To promote job creation. Healthy Huntington Organization 2 Partridge Court Huntington WV 25705 261775212 501(c)(3) 25000 To sponsor fundraising race. Huntington Regional Chamber of Commerce PO Box 1509 Huntington WV 25716 550199470 501(c)(6) 10000 To support economic development in the County. American Cancer Society 611 7th Ave Ste 101 Huntington WV 25701 131788491 501(c)(3) 5250 To support the organization in their fight against cancer. Marshall Artist Series (Marshall Foundation) One John Marshall Drive Huntington WV 25701 556011111 501(c)(3) 10000 To support arts in Huntington, WV. Huntington Symphony Orchestra 763 3rd Ave Huntington WV 25725 237427617 501(c)(3) 5000 To support arts in Huntington, WV. WV Senior Sports Classic 22 Capitol St Charleston WV 25301 550731521 501(c)(3) 10000 To sponsor the Classic Ebenezer Medical Outreach 1448 10th Ave Suite 100 Huntington WV 25701 550745033 501(c)(3) 38500 To support community pharmacy and community health. St Mary's Medical Center Foundation 2900 First Avenue Huntington WV 25702 141887211 501(c)(3) 6600 To sponsor foundation events Boy Scouts of America Troop 106 PO Box 385 Ironton OH 45638 310891212 501(c)(3) 5345 To sponsor 5K run Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: To ensure proper use of funds, the requesting organization is required to document the use of the grant monies. When a request for funds is received and has been approved, the funds are either authorized for use or disbursed to the requesting organization. X 0 0 X X X X 1 0 0 0 0 0 0 0 0 Michael G Sellards 0 583185 0 121616 0 138305 0 16309 0 26293 0 885708 0 0 Todd Campbell 0 320055 0 40717 0 48786 0 9602 0 22703 0 441863 0 0 Angela D Swearingen 0 241223 0 47543 0 150 0 7237 0 22733 0 318886 0 0 Vera Rose MD 264573 0 0 0 0 0 7350 0 23615 0 295538 0 0 0 Susan Beth Robinson 207959 0 16737 0 0 0 6741 0 23527 0 254964 0 0 0 Timothy Parnell 191840 0 19714 0 0 0 6347 0 23498 0 241399 0 0 0 Elizabeth Bosley 174847 0 15673 0 0 0 5716 0 23452 0 219688 0 0 0 Ernest Taylor 280220 0 34875 0 0 0 7350 0 17341 0 339786 0 0 0 Sonya Arthur 148421 0 2981 0 0 0 4542 0 23366 0 179310 0 0 0 Rita Barker 152572 0 5495 0 0 0 4742 0 16996 0 179805 0 0 0 Jeffrey Hamrick 145705 0 0 0 0 0 4371 0 23354 0 173430 0 0 0 David Delimpo 144038 0 0 0 0 0 4321 0 16965 0 165324 0 0 0 David Sheils 132922 0 15181 0 0 0 4443 0 23359 0 175905 0 0 0 Part I, Line 1a Michael Sellards, the CEO, is entitled to reimbursement for reasonable travel expense for his spouse to accompany him to three educational meetings per year; one of which being the West Virginia Hospital Association annual meeting. Part I, Line 4a 4 a: Cheryl Swartzwelder received a payment of $37,406.34. Form 990, Part VI, Section A, line 3 The organization utilizes an outside contractor that supplies a director over the organization's IT staff. The director manages the two IT managers (employees of the organization), who in-turn manage the rest of the IT staff. The director is responsible for completing evaluations for the two managers and then signs off on the evaluations of their staff, which includes the rest of the IT staff. The outside contractor does not have the ability to hire or fire an employee without the approval of the CFO (as would other Directors who are SMMC employees). Form 990, Part VI, Section A, line 6 The organization is a membership (not a stock) corporation under West Virginia state law. The organization's sole corporate member is Pallottine Health Services, a related not-for-profit organization. Form 990, Part VI, Section A, line 7a In accordance with the terms and requirements of its governing documents (i.e. bylaws), on an annual basis, the organization's current board members recommend the list of candidates for membership to the governing body for the subsequent term to the St. Mary's Medical Center board of directors. The board of directors approve and elect these candidates to serve as the organization's board of directors. Form 990, Part VI, Section A, line 7b Pallottine Health Services, as the sole corporate member, also has the right to approve or ratify significant decisions of the organization's governing body including the amendment of bylaws and charters, removal of members of the governing body, and the decision to dissolve the organization. Form 990, Part VI, Section B, line 11 The Form 990 is reviewed by the organization's management in consultation with an independent accounting firm. The financial review is based on the organization's audited financial statements for the relevant time period. Before the Form 990 is filed with the IRS, representatives of the organization's board of directors review the Form 990. A complete copy of the same was provided to the St. Mary's Medical Center full board at their board meeting on July 15, 2014. Form 990, Part VI, Section B, line 12c Upon employment and annually thereafter each key employee and officer of the organization is required to complete a conflict of interest and disclosure form, providing sufficient information about his/her personal interests and relationships so the organization can (1) determine whether any potential or actual conflicts of interest may exist, and (2) monitor work or service assignments to avoid placing the key employee, officer or director in a position where there may be an appearance, potential or actual, of a conflict of interest or a question of objectivity. The completed conflicts of interest and disclosure forms for directors are returned to the organization. In the event that any board member is deemed to lack independence or a conflict of interest exists, he/she is required to leave the room and cannot be part of the discussion or vote. Form 990, Part VI, Section B, line 15 On a regular basis, the organization provides documentation to the compensation committee of the Pallottine Health Services, Inc. board with respect to the compensation of the organization's officers and key employees for review and approval. Such information includes comparable data from similar size tax-exempt organizations in the Huntington, West Virginia community as well as compensation for these positions (as disclosed on form 990) with other organizations in the health care industry that are of similar size, demographics, and geography. Review and approval of the compensation arrangement by the officers/executive committee is documented. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon request at its office at 2900 First Avenue, Huntington, WV 25702. A nominal fee is charged if copies are requested. Evaluation Process for Joint Venture Form 990, Part VI, line 16b The organization has adopted a formal written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements. However, the normal due diligence process for analyzing any such arrangements undertaken in conjunction with the organization's external legal counsel, accountants and other business advisors does include a review to determine the following: 1) the impact of the arrangement under applicable federal and state law 2) whether the arrangement will jeopardize the organization's exempt status as a Section 501(c)(3) charitable organization - hospital 3) whether the arrangement will result in any unrelated business taxable income 4) the impact of the arrangement on any existing contractual agreements or other business relationships and 5) whether the arrangement will result in any conflicts of interest. If there are any concerns with respect to any of the above matters, the organization will take appropriate steps to ensure that, if the joint venture is pursued, the arrangement will be in compliance with applicable federal and state law and to safeguard the organization's tax-exempt status. A formal written policy and procedure has been approved. Hours devoted to related organizations Form 990, Part VII Michael Sellards - 6 hours (PHS, SJH and SMF) Sr. Gail Borgmeyer - 39 hours (PHS) Sr. Diane Bushee - 6 hours (PHS, SJH and SMF) Todd Campbell - 6 hours (PHS and SJH) Angela Swearingen - 6 hours (PHS and SJH) Rita Barker - 4 hours (SJH) Sr. Marian Ruth Creamer - 38 hours (PHS, SJH and PMS) Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Transfer from Affiliates 6,004,793. Change in pension funded status 9,903,294. Loss from affiliate -7,082,722. Tax-Exempt Bonds Schedule K The tax exempt bonds are reported on the Form 990s of St. Joseph's Hospital of Buckhannon, Inc. and St. Mary's Medical Center. Since the bond proceeds are issued on behalf of Pallottine Health Services, Inc., Schedule K has been reported on Pallottine Health Services, Inc. Form 990. St Mary's Medical Management LLC 2900 First Avenue Huntington WV 25702 208017790 Medical Practice WV -7082718 5903361 St Mary's Medical Center Pallottine Health Services 2900 First Avenue Huntington WV 25702 550688201 Parent Oversight WV 501(c)(3) Line 11a, I N/A 0 Pallottine Missionary Sisters 2900 First Avenue Huntington WV 25702 431783315 Church WV 501(c)(3) Line 1 N/A 0 St Mary's Medical Center Foundation 2900 First Avenue Huntington WV 25702 141887211 Foundation WV 501(c)(3) Line 11b, II St Mary's Medical Center 0 St Joseph's Hospital of Buckhannon One Amalia Drive Buckhannon WV 26201 550356996 Hospital WV 501(c)(3) Line 3 Pallottine Health Services 0 St Joseph's Foundation of Buckhannon One Amalia Drive Buckhannon WV 26201 550727650 Foundation WV 501(c)(3) Line 11b, II St Joseph's Hospital of Buckhannon 0 St Mary's Occupational Health Center LLC 2900 First Avenue Huntington WV 25702 542136110 Medical Services WV St Mary's Medical Center Related -57610 63749 0 1 0.51000 Tri State MRI 2900 First Avenue Huntington WV 25702 550669726 Medical Services WV N/A Related -119143 897477 0 1 0.50000 Claire Frances Health Services 200 Mall Road Ste 3 Ashland KY 41101 311517507 Medical Services WV N/A Related 237930 55167 0 1 0.33330 Huntington Area MRI Services LLC 2900 First Avenue Huntington WV 25702 Medical Services WV N/A Related 269002 893618 0 1 0.49000 Vanguard Financial Services 2900 First Avenue Huntington WV 25702 450496141 Collection Agency WV St Mary's Medical Center C 182907 957967 1.00000 0 1 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 St Mary's Medical Management LLC O 406561 Internal accounting records St Mary's Medical Center Foundation O 203119 Internal accounting records Claire Frances Health Services F 125000 Internal accounting records